Caring For Someone With Dementia Towards The End Of Life
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People with dementia may experience problems with thinking, memory, behaviour and mobility. It can be difficult to recognise when someone with dementia is nearing the end of their life. You can support the person by communicating with them and helping them with any symptoms they have. If possible, its a good idea to plan the persons care in advance to help understand what they want from their care.
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Signs Of Dying In The Elderly With Dementia
Dementia is a general term for a chronic or persistent decline in mental processes including memory loss, impaired reasoning, and personality changes. Alzheimers disease is the most common form of dementia, accounting for 60-80% of all cases of dementia. It is also the 6th leading cause of death in the United States, and over 5 million Americans are currently living with Alzheimers disease.
Alzheimers disease and most progressive dementias do not have a cure. While the disease inevitably worsens over time, that timeline can vary greatly from one patient to the next.
Caring for a loved one can be challenging and stressful, as the individuals personality changes and cognitive function declines. They may even stop recognizing their nearest and dearest friends and relatives. As dementia progresses, the individual will require more and more care. As a family caregiver, its important to be able to recognize the signs of dying in elderly with dementia. Hospice can help by offering care wherever the individual resides, providing physical, emotional and spiritual care to the patient and support their family.
Tests For Vascular Dementia
There’s no single test for vascular dementia.
The tests that are needed to make a diagnosis include:
- an assessment of symptoms for example, whether these are typical symptoms of vascular dementia
- a full medical history, including asking about a history of conditions related to vascular dementia, such as strokes or high blood pressure
- an assessment of mental abilities this will usually involve several tasks and questions
- a brain scan, such as an MRI scan or CT scan, to look for any changes that have happened in your brain
Find out more about the tests used to diagnose dementia.
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Take A Break When Needed With Professional Memory Care In South Jersey
Its absolutely normal to feel frustrated, drained, and even angry when a loved one keeps repeating themselves. Youre only human, after all! To avoid snapping, ease your own stress, and manage your response, its important to take a break when you can. If youre having a challenging week, think about calling in a friend or family member to help you out. If youre a sole caregiver, it may be a good idea to think about professional respite care near you. These experienced caregivers understand and work extensively with seniors with memory loss, and can provide a fully trained resource for caregivers to rely on.
At The Shores, leading providers of memory care in Cape May County, we provide on-site, full-time memory care for residents through our Tapestries program, as well as on-site respite care. With activities, social events, outings, and more, were proud to help families and their loved ones with dementia live full, stimulating, and rewarding lives. Contact us today to find out more about techniques for dealing with dementia or memory care in South Jersey, or visit our website at
What Symptoms Signal Late Stage Dementia
Dementia disorders are progressive, meaning they worsen with time. How fast each person changes has a lot to do with their individual health and the cause of their condition.
In the early stages of some progressive disorders, symptoms may vary. For example, people with Lewy body dementia may have more problems with movement and hallucinations than someone with Alzheimers, says the Alzheimers Association.
As the illnesses progress, they share more and more of the same kinds of symptoms. You can tell someone is in a later stage of a progressive brain disorder if they:
- have lost the ability to walk, eat, swallow, sit up, or move around
- need a wheelchair or stay in bed most of the time
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S For Communicating With Someone With Dementia
- Keep yourself in the persons eyeline, and try not to suddenly appear from the side or from behind
- Speak clearly and in short sentences
- If the person is struggling to recognise you, introduce yourself and tell them about the connection between you, for instance: Hello mum, its Julie and I have little Danny, your grandson with me.
- Be reassuring look the person in the eye and smile
- If a person with dementia is getting agitated, take yourself to another room for a few minutes before coming back in, calmly, and saying something like: Hello, Im back now, how lovely to see you.
- Try not to correct the person if they get your name wrong or say something that isnt true this can lead to distress and frustration on all sides. Try to imagine how the person with dementia is feeling
Remember, not being recognised does not mean you are totally forgotten.
How Can I Support Someone With Dementia Towards The End Of Life
Knowing the person will make it easier to provide person-centred care that is focused on what they need and want. It can help to know about their likes, dislikes and their wishes for how they want to be cared for. If the person isnt able to tell you about themselves, speak to their family, friends or other people who know them well.
Its a good idea to find out if the person has a copy of This is me , a document that records information about themselves. If you cant speak to the person, ask those close to them if they have a copy. They may have these details recorded in their care plan.
There are many ways to support someone with dementia at the end of life.
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What Are The Main Types Of Dementia
Alzheimers disease is the most common cause of dementia, accounting for around 2 out of every 3 of cases in older people. Vascular dementia is another common form, while dementia with Lewy bodies and frontotemporal dementia are less common.
It is possible to have more than one type of dementia at the same time. Alzheimers is sometimes seen with vascular dementia or dementia with Lewy bodies. You might hear this called mixed dementia.
The symptoms of dementia vary depending on the disease, or diseases, causing it. You can read more about the symptoms associated with different types of dementia on the Alzheimers Society website .
Are They Starving Or Dehydrating To Death
It may seem that the person is being starved or dehydrated to death, but they are not. In the end stages of dementia , the persons food and fluid intake tends to decrease slowly over time. The body adjusts to this slowing down process and the reduced intake. It is thought that by this stage the hunger and thirst part of the brain has now stopped functioning for most people.
The person may be immobile and so does not need the same amount of calories to sustain their energy levels. Having reduced food and fluid intake and decreased interest in this can be thought of as a natural part of end of life and dying.
Giving increased food and fluids artificially can be helpful for some other health conditions, but it is usually not considered to be helpful at the end of life in dementia as a way of managing reduced oral intake.
Ways To Care For Someone With Vascular Dementia
If youre caring for someone whos had a stroke, then you know forgetting words, dates and faces is pretty common. However, a stroke can trigger other kinds of memory loss, such as trouble planning, making decisions and reasoning. This type of memory loss is called vascular dementia.
Though its symptoms may be similar to Alzheimers disease, vascular dementia is caused by stroke blocked blood vessels in the brain. When areas of the brain are deprived of blood and oxygen, brain cells die. This can cause memory loss.
Any type of memory loss can feel devastating, whether its vascular dementia, Alzheimers, or frontotemporal dementia. But there are many tools and resources to help your family cope. Here are 5 ways you can care for your loved one.
Types Of Vascular Dementia
Vascular dementia can be divided into two types: post-stroke dementia and multi-infarct dementia .
POST-STROKE DEMENTIASymptoms are most obvious when they arise suddenly following a stroke, resulting in the blood supply to the brain being suddenly interrupted due to a blocked artery. This disruption can lead to damage or death of brain tissue. Not all stroke victims develop dementia it is estimated that approximately 20% of stroke patients develop post-stroke dementia within six months. Post-stroke dementia can result in physical symptoms and/or problems with vision or speech. Symptoms depend on what area and how much of the brain is affected.
MULTI-INFARCT DEMENTIAThis type of dementia results from a series of mini-strokes in vessels located deep within the brain . These mini-strokes may not lead to any sudden obvious onset of symptoms however, even these âsilent brain infarctionsâ still increase the risk of dementia, a result of disease of the brainâs blood vessels. Over time, the effects of this damage can result in dementia. Progression is referred to as âstep-wiseâ because symptoms worsen after any additional mini-strokes and then remain the same for a time. Symptoms that may develop include changes in reasoning and other thinking skills such as memory, as well as mood and behavior problems, including depression and apathy.
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A Person With Dementia Doesnt Always Fit Into One Stage
Dementia affects each person in a unique way and changes different parts of the brain at different points in the disease progression.
Plus, different types of dementia tend to have different symptoms.
For example, someone with frontotemporal dementia may first show extreme behavior and personality changes. But someone with Alzheimers disease would first experience short-term memory loss and struggle with everyday tasks.
Researchers and doctors still dont know enough about how these diseases work to predict exactly what will happen.
Another common occurrence is for someone in the middle stages of dementia to suddenly have a clear moment, hour, or day and seem like theyre back to their pre-dementia abilities. They could be sharp for a little while and later, go back to having obvious cognitive impairment.
When this happens, some families may feel like their older adult is faking their symptoms or just isnt trying hard enough.
Its important to know that this isnt true, its truly the dementia thats causing their declining abilities as well as those strange moments of clarity theyre truly not doing it on purpose.
Helping Someone With Vascular Dementia
Caring for a person with vascular dementia can be very stressful for both you and your loved one. You can make the situation easier by providing a stable and supportive environment.
- Modify the caregiving environment to reduce potential stressors that can create agitation and disorientation in a dementia patient.
- Avoid loud or unidentifiable noises, shadowy lighting, mirrors or other reflecting surfaces, garish or highly contrasting colors, and patterned wallpaper.
- Use calming music or play the persons favorite type of music as a way to relax the patient when agitated.
Stage : Mild Dementia
At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:
- Difficulty remembering things about one’s personal history
- Difficulty recognizing faces and people
In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.
Key Points About Vascular Dementia
- Vascular dementia is a disorder characterized by damaged brain tissue due to a lack of blood flow. Causes can include blood clots, ruptured blood vessels, or narrowing or hardening of blood vessels that supply the brain.
- Symptoms can include problems with memory and concentration, confusion, changes in personality and behavior, loss of speech and language skills, and sometimes physical symptoms such as weakness or tremors.
- Vascular dementia tends to progress over time. Treatments can’t cure the disease, but lifestyle changes and medicines to treat underlying causes might help slow its progress.
- Surgical procedures to improve blood flow to the brain can also be helpful. Other medicines might slow the progression of dementia or help with some of the symptoms it can cause.
- A person with vascular dementia may eventually need full-time nursing care or to stay in a long-term care facility.
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Who Gets Frontotemporal Dementia
FTD can affect anybody. It typically affects people at a younger age than Alzheimers disease, with symptoms beginning in the 50s or 60s, and sometimes younger.
Almost a third of people with FTD have a family history of dementia. However, only about 10-15% of cases have familial FTD, in which a gene mutation is passed on that causes the disease.
The genetic basis of FTD is not fully understood and is actively being researched.
Find Out As Much As Possible
Your friend or family member is going to need more care as their condition gets worse, which may fall to you. Becoming a carer is not something most people feel prepared for. So you need to find out as much as you can at the start.
Talk to their doctor and make sure you understand your friend or family members condition and how its likely to change. Ask your GP and local council about the support you can get. If you work, speak to your employer to see what help they can offer you. Find out about the benefits you may be able to receive if youre not working or if you have to stop.
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Support For People With Dementia And Carers
UCL covid-19 decision aid – a tool to support carers of people living with dementia to make difficult decisions during covid-19
Alzheimers Society end of life care information for patients and families
Alzheimers Society information and fact sheets on all aspects of dementia including what is dementia, types of dementia and living well with dementia
Alzheimer Scotland specialist services for patients and carers
Dementia UK expert one-on-one advice and support to families living with dementia via Admiral Nurses
What You Can Do For Your Loved One
As an individual with dementia declines, you can help them by providing a loving and supportive presence. Sit with them. Hold their hand. Play music they enjoy.
One of the greatest gifts you can give your loved one is helping to get their affairs in order. Ensure that financial and healthcare powers of attorney are put in place, so you can make decisions when your loved one is no longer able. Look into funeral arrangements before you need them, so you dont need to make important decisions in a time of crisis.
Talk to your loved ones physician about the possibility of palliative care support in the home and hospice care when your loved one is ready.
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Is Artificial Nutrition And Hydration A Good Idea
Most health professionals now feel that a person with advanced dementia and in the end stage of their illness should not be fed by tubes or drips. This is because inserting tubes or IV drips requires hospital admission, which can be very distressing for the person. They may then pull out the tubes and drips, and the site of the tubes and drips can become infected and sore.
He was very distressed in hospital and kept pulling out his tubes he didnt understand what was happening to him and they didnt know how to help him.
Ghost Towns: Nursing Home Staffing Falls Amid Pandemic
SYRACUSE, N.Y. When Natalie Walters arrived at her fathers nursing home, the parking lot was nearly empty and, inside, the elevator made no stops. On the 13th floor, the lights were off and the TVs silent. The last time she was allowed inside, nine months earlier, aides passed in the hall and a nurse waved from the records room.
Now, it felt like a ghost town.
One of the few staffers on duty broke the news: Walters was too late and her father was already dead of COVID-19. In the nursing homes newfound emptiness, the scream she unleashed echoed in the void.
It was so still and quiet, says Walters, whose description of desolation at the home aligns with records showing its staffing level has fallen over the course of the pandemic. How alone must he have been.
Even before COVID-19 bared the truth of a profit-driven industry with too few caring for societys most vulnerable, thin staffing was a hallmark of nursing homes around the country. Now, staffing is even thinner, with about one-third of U.S. nursing homes reporting lower levels of nurses and aides than before the pandemic began ravaging their facilities, an Associated Press analysis of federal data finds.
Its already so low. To drop further is appalling, says Charlene Harrington, a professor at the University of California, San Francisco, whose research on nursing homes has frequently focused on staffing.
Most U.S. facilities dont meet that threshold.
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